The fight against the global obesity epidemic has become one of the most pressing problems of humanity in the 21st century. Representatives of the authorities and expert communities discussed possible ways of solving it during the October forum “Obesity, Metabolism and Life Expectancy”, which was held under the auspices of the All-Russian Union of Patients in Moscow.
The Forum brought together representatives of the Ministry of Health of Russia, regional authorities, employees of the Russian Bureau of WHO, leading specialists in the field of endocrinology, therapy, cardiology, dietetics, bariatric surgery, clinical pharmacology, representatives of the scientific community and the pharmaceutical industry, who discussed the most effective ways to solve the global problem of the obesity epidemic and metabolic diseases. The general sponsor of the forum was the Novo Nordisk company.
According to the WHO, today every third person on the planet is overweight: the problem of obesity, metabolic health and associated diseases is not accidentally called the “epidemic of the XXI century.” The most convenient formula to check for obesity is body mass index (BMI). It is calculated as the ratio of body weight to the square of height in meters (kg / m²). Overweight is indicated by a value above 25, obesity – above 30.
Extra pounds negatively affect health, increasing the risk of cardiovascular and oncological diseases, infertility, and can even shorten life expectancy, and therefore pose a global threat to all mankind: due to diseases associated with overweight, more than 2.8 die million people annually.
In Europe, the prevalence of obesity hovers around 15-25% among the adult population. As for Russia, obesity was detected in 21.6% of adults, and 40% of our compatriots are overweight in general. Russian women suffer from extra pounds more often than men (every third against every fifth). In total, according to the WHO, 1.9 billion people over 18 years of age were overweight in 2016. Since 1975, their number has grown at least threefold.
The risk of developing certain chronic diseases is often associated with being overweight. A high BMI, according to studies, indicates the risk of developing heart and vascular diseases and often provokes type 2 diabetes. According to expert estimates, about 90% of people suffering from this disease are overweight or obese.
How cities are associated with being overweight
Among the main reasons for the growing obesity epidemic are urbanization and decreased physical activity, mainly associated with sedentary work and the development of the transport system, as well as the consumption of high-calorie foods. The abundance of simple, easily digestible foods and polyunsaturated fats in the diet is one of the easy ways to gain weight.
In rural areas, at first glance, the number of residents with a high BMI should be less: here people are more often engaged in manual labor, spend more time outdoors, they are not so densely surrounded by fast food restaurants and electric scooter rentals. However, data from a study published in the journal Nature suggest the opposite: on average, city dwellers gain weight no faster than rural residents. From 1985 to 2017, more than 55% of the increase in BMI accounted for those who live outside the city.
Reorganizing the public catering system can improve the urban environment. Thus, studies show that the presence of fast food within walking distance increases the risk of developing excess weight among local residents. It has been proven that people who live in places where there are many fast food restaurants are more likely to develop type 2 diabetes. At the same time, the presence of ordinary restaurants near the house either does not affect the extra pounds at all, or even leads to the opposite, positive results.
A selective observation by Rosstat, conducted in 2018, showed that, per 10 thousand inhabitants, Moscow shows the lowest concentration of fast food among Russian cities: there are only three of them per 10 thousand people, while in other cities it varies in area 6-7. This explains the smaller – in comparison with the rest of Russia – consumption of calories by Muscovites (2320 kilocalories versus 2920) and sugar (21.3 kg versus 31.1 kg per year).
A sociological study carried out by KB Strelka and Novo Nordisk within the framework of the global program “Cities are Winning Diabetes” showed that Muscovites are more interested in food outlets with healthy food than residents of other cities.
“Among the factors contributing to the prevention of obesity, in addition to the habit of leading a healthy lifestyle, the role of a healthy urban environment should not be underestimated,” says Sergei Reshetnikov, General Director of Novo Nordisk. The Cities Win Diabetes program, launched by Novo Nordisk and partners in 2014 and launched in Moscow in July 2021, aims to study the barriers and risk factors in the urban environment that hinder the prevention and control of obesity and diabetes. “
Among other important points of the program is the emergence in cities of conditions for stimulating maintaining physical activity by creating elements of urban planning with a high index of pedestrian accessibility. Another element is the development of green spaces. Living near them has been shown to reduce the risk of obesity and diabetes. Green areas have low noise levels and are conducive to walking and physical activity, which also contributes to weight loss.
In general, to create a healthy environment in cities, it is necessary to attract specialists from a wide variety of industries. And of course, such changes are difficult to imagine without the participation of the city authorities.
How the obesity epidemic affects children
In many ways, the problem of overweight in children is underestimated: if earlier it was a problem in high-income countries, now it has captured almost the entire world. Up to five years, overweight, according to WHO, affects 41 million children, and among the group 5-19 years old – 340 million. Since 2000, the number of obese children in Africa has grown by 50%.
The long-term effect of this trend is also difficult to assess because excess weight gained in childhood can spread into adulthood. For example, in Russia every fifth child is overweight or obese, and in half of these children, excess weight may persist into adulthood.
The speakers unanimously agreed that the problem of excess weight should cease to be a problem for each individual person. After all, the diseases to which it leads, affect the quality of life of people, their ability to work, increase the costs of the health care system and, in general, affect the welfare of the state. Therefore, it is most effective to solve this problem at the state level.
The current trend can be reversed by comprehensive measures: it is necessary to improve diagnostics, including expanding screening programs for the early detection of overweight and obesity, provide access to innovative therapy, update clinical guidelines for the diagnosis and treatment of obesity, develop clinical guidelines for overweight, create a system prevention and patient routing. Representatives of the expert community discussed specific proposals during the Obesity, Metabolism and Life Expectancy Forum.
For example, in order to introduce the child population to a healthy lifestyle, it is necessary to implement programs in schools and kindergartens to reduce and prevent risk factors for the development of obesity in schoolchildren and preschoolers. For children who have already encountered it, the most innovative methods of treatment should be available. The situation is already beginning to change: in hospitals all over the country, the obligatory entry of the child’s BMI into outpatient cards and the registration of obese children with dispensary have been introduced.
According to Valentina Peterkova, Academician of the Russian Academy of Sciences Valentina Peterkova, scientific director of the Institute of Pediatric Endocrinology at the National Medical Research Center of Endocrinology of the Ministry of Health of the Russian Federation, the problem of childhood obesity cannot be solved without the involvement of school administration, education departments, social structures and without a wide range of medical specialists. “Obesity makes a huge contribution to reducing life expectancy. First of all, it is necessary for doctors and the population to learn that obesity is a disease. It is a global interdepartmental problem. It cannot be solved without the help of the school, the department of education, social structures, and an integrated approach of all medical specialists. It is important to conduct educational activities. The main efforts should be directed towards this, “says Valentina Peterkova.
In addition, the forum participants noted the need to supplement diagnostic studies within the framework of medical examination and professional examinations. In particular, there were proposals for the widespread expansion of screening programs for various diseases and metabolic disorders, including for the early detection of abnormalities associated with metabolic changes. It is possible to facilitate patient access to innovative therapy for obesity if modern drugs are included in the program of state guarantees for the provision of free medical care, which is most important for people with morbid obesity.
In this situation, the issues of preventing excess weight deserve priority attention from the point of view of updating the clinical recommendations for the treatment of obesity in children and adults.
During the forum, experts discussed many ways to solve the problem of obesity and announced the preparation of a roadmap, which will include specific proposals to amend legislation and develop measures to prevent and treat obesity. One of the most important proposals is to add obesity to the list of socially significant diseases in order to focus on the medical, social and economic consequences of this pathology, to develop special government programs to help such patients. This was announced by the co-chairman of the All-Russian Union of Patients, Yuri Zhulev.
According to Ekaterina Troshina, Deputy Director of the National Medical Research Center of Endocrinology of the Ministry of Health of the Russian Federation, Director of the Institute of Clinical Human Endocrinology, Corresponding Member of the Russian Academy of Sciences, it is important to prevent obesity in those who do not have it and to help those who already suffer from it.
“Today there is a problem of underdiagnosis of obesity as a disease. Less than a third of people with this disease have been diagnosed with such a diagnosis,” Troshina notes. “And many doctors and many patients do not perceive obesity as a disease. eight years. Late conversion makes the problem of public awareness of the importance and, in fact, fatality of obesity, which kills more often than smoking, is very urgent. “